Launched in Brussels, Belgium, at the start of Heart Rhythm Week (1–7 June 2015) the “Future of Anticoagulation Report” highlights that urgent action is critical to lessening the potential impact of atrial fibrillation. With an aging population in Europe and the prevalence of atrial fibrillation expected to double in the continent by 2060, the condition looks likely to become a future health issue for millions of Europeans.

Researched and written by RAND Europe with contributions from a panel of leading European medical, patient group and health economic experts, the report explores how decisions made today can change and reshape the landscape of tomorrow and have the potential to make a significant difference in changing the direction of this disease in terms of prevalence and impact. The “Future of Anticoagulation” initiative was supported financially and in kind by Daiichi Sankyo Europe.

Atrial fibrillation is expected to be a leading health burden in the EU in the coming years. It is the most common sustained arrhythmia affecting approximately 1.5–2% of the population in the developed world. Atrial fibrillation increased the risk of stroke by five times and a the risk of heart failure by three times. Strokes that result from atrial fibrillation are more severe and are associated with a high risk of mortality (32.8%) and with a 50% probability of remaining disabled or handicapped within three months of the event. Therefore, the increasing number of adults with the condition will have major public health implications across Europe over the coming decades. Although new medical therapies have been developed and recommendations for diagnosis and treatments aligned in Europe in the last few years, atrial fibrillation is still under or not treated in many cases.

The “Future of Anticoagulation Report” outlines three primary short-term recommendations; improve atrial fibrillation awareness amongst the public and policy makers, support education about the condition’s management for healthcare professionals and patients, and maintain related research across the health services to be able to monitor what works best in terms of healthcare interventions.

“This report is a wake-up call for healthcare professionals and policy makers across Europe to work together to better manage atrial fibrillation, as its burden looks set to double as our population ages,” explains John Camm, chair of the Future of Anticoagulation Steering Committee, professor of Clinical Cardiology, St. George’s, University of London and Professor of Cardiology, Imperial College London, UK. “I would especially like to highlight that we need to improve healthcare policies related to atrial fibrillation, including improving diagnosis and supporting earlier treatment interventions, such as effective modern anticoagulant medicines, to ensure that we can ultimately prevent avoidable deaths across the continent.”

The study aims were to assess the current landscape and challenges for the management of atrial fibrillation in Europe, and explore how this landscape could evolve. It focused on six key countries in Europe; Belgium, France, Germany, Italy, Spain and the UK. The two main goals of the study were to develop an evidence base on the current reality of atrial fibrillation-related anticoagulation management in these six countries and to develop an understanding of actions that could be taken today to improve the outlook for future management. The methods of research comprised a literature review and assessment, and 60 interviews carried out with a range of experts representing various stakeholder groups such as healthcare professionals, patient representatives and policymakers. In addition, a steering committee made up of 10 experts in cardiology and related areas from the six European focus countries and an international patient group representative were actively involved in the development of the report.

“Through the research we conducted and the insights gathered from the broader atrial fibrillation community, one overriding message has crystallised: there will be significant human and economic consequences in the coming years if clear steps are not taken now to stem the rising burden of atrial fibrillation,” commented Joanna Chataway, research group director, Innovation, Health and Science, RAND Europe.

Detecting an irregular heart rhythm might be as simple as a manual pulse check, with any unusual rhythm verified with an electrocardiogram (ECG). Trudie C Lobban founder and chief executive officer of the Atrial Fibrillation Association (AFA) explained, “Lives can be saved if only people begin to regularly check their pulse. Early diagnosis is more challenging if few people know about atrial fibrillation or its symptoms, and if it goes undiagnosed, opportunities for earlier interventions and treatment to prevent atrial fibrillation-related stroke are missed entirely. The Atrial Fibrillation Association welcomes this timely report that underscores how important it is to detect, protect and correct heart rhythm disorders across the EU.”

The report’s longer-term recommendations include: (i) taking a longer-term view in decisions on spending for atrial fibrillation awareness, education, care and management that are considered vital for improving health outcomes; (ii) continuing improvement in patient stratification (such as based on biomarkers or health imaging) that can lead to enhanced personalisation of treatment and medical care; (iii) encouraging greater interaction among primary, community, secondary and tertiary healthcare professionals to enable greater knowledge sharing and more whole-patient approaches to care; and (iv) enhancing monitoring via developments in devices and data is also needed to maximise benefits of atrial fibrillation management.